Special issue with the Sunday Magazine
From the publishers of THE HINDU

ADIVASI : JULY 16, 2000

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A better quality of life?

Dr. Roopa Devadasan and Dr. N. Devadasan

The World Health Organisation defines health as a complete state of physical, mental, social, and spiritual well being and not merely an absence of disease. The common man, the world over understands this better than many health professionals, and no one is better placed than the adivasis to actualise this state of well being; for as communities they have not lost a holistic vision of life.

M. Anand

Unfortunately, in society, the polarisation between the rich and poor is increasing. Adivasis in India are struggling to make both ends meet. Displaced from their natural forest habitats, their economic, social and psychological poverty is steadily increasing. It is in this context that we must look at tribal health.

Tribals in different parts of India, and even within the same geographic regions are at different stages in this transition. At one end of the spectrum are those "untouched by civilisation". These groups still inhabit the forests that are closely linked to every aspect of their lives. It must be stressed that these people generally enjoy a healthy lifestyle. Their daily routines with periods of work and rest are linked strongly to seasonal cycles. They often have a balanced diet accessed through agriculture, hunting and food gathering. Here people's concept of health is more functional than biomedical, in that a person is considered healthy unless she/he feels incapable of doing normal work assigned to that age/ sex in that culture. The cause of illness is also attributed to specific acts of commission or omission, "spirits", or in some cases physical factors in the environment. Healing can take place through a herbal preparation or an act of atonement, all advised by a shamanic medium. This scenario is steadily changing, and will rapidly be a thing of the past.

At the other end of the spectrum is the adivasis displaced completely from the forest, whose modern lifestyle mirrors many of the problems of our age. As opportunities in mainstream society are limited, these people suffer all the ills of the very poor. In addition, they suffer social discrimination as the outside world has a stereotyped image of the "uneducated junglee". Through interaction with other groups in society, they may follow a more clinical/ biomedical model of health and disease and accept other systems of medicine - allopathy, ayurveda and siddha. However, as there is a difference in the very expression of the symptom complex, understanding of the causation of illness and even the language used for communication, there can be huge gaps in the process of healing.

The vast majority of tribal people lie somewhere in between these poles.

The list of illnesses that they suffer from is similar to their non-tribal counterparts. They suffer from communicable disease and non-communicable, lifestyle induced disorders, the proportions varying, depending on which pole they are closer to. A minority suffers from a few genetically determined disorders like sickle cell anaemia, thalassemia and G-6-PD deficiency. The difference lies in the extent of suffering that the tribal undergoes, which is further accentuated by an unsympathetic health service. The derogatory behaviour of the staff undermines their confidence and self-esteem and builds on their existing fear. This is turn results in a tremendous reluctance to approach the health services. A classic example of this is the high maternal mortality among their women.

Our own experience in understanding tribal health needs stemmed from our trying to respond to the needs of the five tribal groups living in the Gudalur taluk of the Nilgiris in Tamil Nadu. As fresh graduates with a strong community health training from CMC Vellore, we joined the NGO-ACCORD in 1987 and started looking for solutions. Greatly supported by the community organisation work that had already begun among the tribal people to fight for their land rights, the sanghams and the health workers that they chose became our partners in the search. We discovered that whenever the hamlets had access to forest and land they were never impoverished, nor their children malnourished. The bountiful Mudumalai forests met all their basic needs. When dispossessed of their basis resources like land, or access to forest, they quickly fell prey to their exploitative non-tribal neighbours, and soon found themselves in debt.

Caught in this trap, their predominant emotions were fear and mistrust. The attitude of these non-tribals (ranging from their neighbours to the health professionals) did not help. So they preferred to die a dignified death in the village rather than seek medical help.

The village health workers through sheer hard work and perseverance were able to build their faith in the alternative allopathic system we proposed. As we went along we learned to look at health through their eyes and facilitated their own system of healing being transferred wherever we could. While we started out hoping that as the fear went they would slowly access the government systems, with time we realised the futility of expecting the Government Taluk hospital and the Primary Health Centres to function. In 1990, the Gudalur Adivasi Hospital came into being, now a 30-bedded institution owned and run by the Adivasi Munnetra Sangam. In keeping with all the lessons learned, the staff is entirely adivasi and their own philosophy and culture provide the foundation for its management.

In terms of a learning experience that has also been validated in other tribal belts in the country, some things are outstandingly clear and bear reflection and acting upon. There is an immense need for sympathetic sociological research towards improving the quality of life of the adivasi people. For raising the level of health for these people, a multisectoral, holistic effort must be implemented. It is a myth that tribal people do not utilise modern systems of medicine. Rather poor utilisation is due to geographical, financial and socio-cultural barriers. Inefficiency and lack of accountability of the health services and the ever-present corruption only add to the problems of these people. Finally, in the context of the growing concerns about the ecosystems and environment, an increasing interest in herbal remedies, and a return from the reductionist scientific view of health to a more holistic perspective, we have much to learn from the adivasis. After all their very survival from another era must teach us something.